nephrology training

AST/ASN Renal Transplant Fellowship Training Certification Program

The AST/ASN Renal Transplant Fellowship Training Accreditation Program (the "Program") is charged with accrediting institutions that have developed programs to provide specialty training to Board-Eligible or Board-Certified nephrologists. As a result of the Program’s approval by UNOS, graduates of accredited programs are qualified to head UNOS approved renal transplant programs. The goal of this Program is to provide a basis for the standardization of transplant training and a method of uniform documentation of education for those who wish to lead renal transplant programs.

Application Process

An application must be completed online. The application fee of $2,000.00 (checks made payable to "AST/ASN") should be sent to the AST National Office. The application fee covers administrative fees and travel expenses associated with the site visit (discussed below). If the AST/ASN Renal Transplant Fellowship Training Accreditation Committee (the "Committee") determines, based on its review of the application, that an applicant transplant program is unsuitable for site visit review, the application fee minus $200.00 will be returned to the applicant.

Site Review

Each applicant for program accreditation will be visited by two members of the Committee which is composed of nephrologists or transplant surgeons chosen from the ASN and AST membership. Accredited transplant training programs will be site visited by one or two reviewers at the discretion of the Committee in connection with their re-accreditation every six years. Committee members will be assigned to evaluate programs in geographic regions distant from their own programs. Prior to the site visit, the names of the site reviewers will be sent to the applicant program’s Program Director. If the Program Director objects to the reviewer(s), the Committee will select an alternate reviewer(s). The site visit will include discussions with the medical director of the transplant program, the transplant fellowship program director, the transplant surgical director, research director, transplant pathologist, a general nephrology fellow and a current renal transplant fellow, if there is a fellow in training. Additionally the hospital wards and clinic, the program survival data, and the outlined didactic program will be reviewed. A standardized form will be completed by the site visitors and submitted for final review to the AST Executive Committee and the ASN Program Directors Executive Committee.

Application and Review Time Line for New Applicants

New applications will be accepted at any time. The review process including the site visit will occur within one year following the receipt of the application by the Committee. The chairperson of the Committee will communicate the review summaries to the ASN Program Directors Executive Committee and AST Executive Committee. Notification of a decision with respect to accreditation will be provided to the prospective programs via certified letter from the chairperson of the Committee.

Due process

If a program is denied accreditation, the program may reapply after correction of the identified deficiencies. A program has the option to withdraw its application at anytime. If a program feels the decision of the Committee is incorrect, a program may appeal the decision to the ASN Program Directors Executive Committee and the AST Executive Committee. The appeal must be submitted to the Executive Committees within 60 days of the Committee’s initial accreditation decision. A final decision will be communicated to the program director within 120 days of receipt of the appeal.

Accreditation and Re-accreditation

Once the Committee accredits a program, the accreditation will be in effect for three years. Each accredited program is required to submit an annual report to the AST National Office. Such reports are to be submitted on the form prescribed by the Committee, which form solicit the name(s) of those individuals trained or being trained by the program and the number of renal transplants performed. Each accredited program is obligated to pay an annual renewal fee of $600.00 which will be billed in January of each year. Furthermore, each accredited program must apply for re-accreditation every three years on a form prescribed by the Committee and a re-accreditation site visit will be made every six years (as described above). The re-accreditation fee is $1000.00 at three years and $2500.00 at six years when a site visit is required. Failure to submit re-accreditation applications within six months following the expiration of a program’s current accreditation will result in a loss of such program’s accreditation, with consequences as described below.

Loss of Accreditation

If deficiencies in an accredited program are noted by the Committee based on the program's annual report, re-accreditation application, site visit report or otherwise, the program will be notified by Certified Mail within 30 days of the Committee’s review of the annual report. The program shall be placed under review for a period of two years to address the deficiencies noted by the Committee. Some of the deficiencies that may result in placement of a program under review and eventual loss of accreditation include, but are not limited to, minimum number of kidney transplants not met, inadequate training of fellows, loss of medical director and not training a fellow for over 5 years.

While the program is under review, the program must notify all current and prospective enrollees promptly that the program is under review. Programs that are under review cannot enroll new fellows.

Loss of accreditation will occur if the eligibility criteria continue not to be met after a program has been under review for two years. While a program is under review, it will be obligated to provide interim reports regarding its status every six months. Notification of loss of accreditation will be sent by Certified Mail from the Presidents of the AST and the ASN.

Reinstitution of Accreditation

If a program loses accreditation, it must reapply de novo, i.e., it must satisfy the eligibility criteria, submit a completed application form, pay the application fee and host a site visit. Additionally, a program that is applying for reinstitution of accreditation must submit a statement explaining the steps taken to prevent the reasons for the original refusal or loss of accreditation from occurring in the future.

Eligibility Criteria

Each of the following criteria must be continuously satisfied by an accredited renal transplant fellowship training program:

1) The transplant program must be UNOS approved as a Renal Transplant Program and be affiliated with an ACGME approved nephrology program. Notwithstanding the preceding sentence, transplant programs that are not UNOS approved and/or affiliated with an ACGME approved nephrology program will be evaluated by the Committee on a case-by-case basis.

2) The program director must be a transplant nephrologist who would be eligible for membership in the AST and ASN.

3) The program must have a full-time faculty member or members capable of teaching a curriculum with a broad base of knowledge in transplant medicine. The curriculum must include training and experience in end-stage renal disease management, training in the selection of appropriate transplant recipients and donors, experience in the immediate and long term care of the transplant recipient, and training in the performance of renal transplant biopsies. Additionally, there must be an emphasis on the management of immunosuppressive agents and the evaluation of renal transplant dysfunction. Combined surgical and medical rounds should be conducted on a regular basis. It is strongly recommended that the didactic section of the program follow the AST's Primer on Transplantation.

4) Prospective renal transplant fellow candidates are individuals who, at the time of matriculation into an accredited renal transplant fellowship training program, are Board-Eligible or Board-Certified nephrologists. This may include participants in three-year nephrology programs who have or will have successfully finished two years of nephrology training and are eligible for the nephrology boards.

5) Each fellow’s training must be completed within 12 continuous months. A minimum of six months of training must be performed in inpatient clinical service and the remaining training period should be designed to gain experience in tissue typing, experience on another organ transplant service or clinical or basic research projects associated with transplantation.

6) Each year, the transplant program must perform at least 10 renal transplants for each first-year general nephrology fellow and an additional 30 transplants for each renal transplant fellow. This criterion ensures that the renal transplant fellowship program will not encroach upon the RRC-IM requirement that all nephrology trainees must manage 10 new transplant recipients.

7) The program must provide patient co-management responsibility with transplant surgeons from the peri-operative through the outpatient period. The renal fellow must primarily manage the transplant recipient's medical care including hypertension, diabetes, and dialytic problems. Fellows must also serve as primary members of the transplant teams and participate in making decisions about immunosuppression. Each fellow must be primarily responsible for 30 inpatient renal transplant recipients and 30 outpatient recipients. Outpatient follow-up must be continuous for a minimum of at least three months.

8) The program must provide training in: a) the indications for, b) the performance of, and c) interpretation of, renal transplant biopsies. Each fellow must perform a minimum of 10 transplant biopsies during the training period. Documentation of the completion of these biopsies is required. Furthermore, the program must provide didactic pathological experience with the fellow reviewing renal transplant biopsies with an experienced renal transplant pathologist.

9) Each fellow must observe at least three renal transplants (deceased or living donor) and also must observe at least three organ recovery procedures.

10) Documentation that the fellow has performed the prerequisite number of 30 in-patient and 30 outpatient recipient encounters; 3 surgical observations, 3 procurement observations and 10 renal transplant biopsies must be kept by the fellow. Documentation should, at a minimum, be in the form of a log that contains the date of patient contact, type of examination, type of procedure performed or observed and the signature of the transplant physician present.

11) The fellow will be required to complete an evaluation form six months into the program and at the completion of the 12-month fellowship. Each training program director will be responsible to ensure that the fellow receives and completes the forms. The forms should be sent by the program director to the AST National Office. Upon receipt, the Committee will review the forms.

12) The renal transplant fellowship program director must provide a letter to each fellow within two months of successful fellowship completion, stating that the fellow has met all of the above criteria and is capable of being certified as a UNOS transplant physician. A copy of this letter along with a written statement validating the transplant fellow's participation in the required didactic sessions and patient management experiences must be sent to the AST National Office for the program file and a copy of the letter should be given to the fellow.

Submit an online application for initial accreditation, three-year reaccreditation, or six-year reaccrediation and submit payment.